From CT Suite to Catheterisation Laboratory: Cardiac CT as a Procedural Roadmap for Complex Percutaneous Coronary Intervention

Cardiac computed tomography (CT), particularly coronary CT angiography (CCTA) and its analytical derivatives, is emerging as a cornerstone of precision imaging in interventional cardiology. This Research Topic reconceptualises CCTA as a procedural roadmap for complex percutaneous coronary intervention (PCI), extending its role beyond diagnosis to encompass procedural planning, guidance, and follow-up. Central to this vision is the CT-centred imaging pathway—how anatomical models, CT-derived fractional flow reserve (CT‑FFR), plaque quantification, and calcium scoring can inform and integrate into the catheterisation laboratory. Contributions are invited exploring CT-guided pre‑procedural planning, CT‑FFR‑based revascularisation, CT–intravascular imaging fusion, photon‑counting CT (PCCT), post‑procedural CT surveillance, and clinical adoption of CT‑first workflows in complex PCI.Cardiac CT now delivers anatomical and functional insight surpassing traditional angiography, particularly for chronic total occlusions, left main disease, bifurcations, and calcified lesions. Modern CCTA defines vessel geometry, occlusion morphology, and access routes—information vital for anticipating procedural difficulty and optimising strategy. Advances such as CT‑FFR enable vessel‑specific physiological assessment, while quantitative plaque analysis, calcium scoring, and biomarkers like the perivascular fat attenuation index (FAI) enhance lesion characterisation and risk profiling. Photon‑counting CT further advances resolution and tissue differentiation, opening new frontiers for procedural planning in complex anatomy.The next challenge is translating CT-derived intelligence into real-time interventional use. Emerging techniques—CT/angiography co‑registration, CT/IVUS and CT/OCT fusion—enable overlay of pre‑procedural roadmaps onto live imaging, yet robust evidence on clinical outcomes remains limited. Post‑PCI, CCTA increasingly supports non‑invasive stent surveillance and detection of subtle complications, defining an end‑to‑end CT workflow that remains to be standardised.This Research Topic aims to establish an evidence-based framework for integrating CT across the PCI continuum—enhancing procedural planning, safety, efficiency, and patient‑specific precision.To advance this field, we welcome submissions addressing, but not limited to, the following themes:• CT-based planning for complex lesions (chronic total occlusion, bifurcations, left main, heavily calcified arteries);• CT‑FFR and anatomy–physiology integration for revascularisation planning;• Quantitative plaque analysis and CT biomarkers (calcium score, plaque vulnerability, FAI);• CT/invasive imaging co‑registration, image‑based navigation, and validation studies;• Photon‑counting CT and spectral imaging for interventional planning;• Post‑procedural CT surveillance and comparisons with invasive strategies;• Workflow integration, CT‑first adoption models, operator training, and health‑economic analyses.We welcome original research, clinical trials, reviews, technical reports, brief communications, and illustrative case series, particularly those addressing real‑world implementation and guideline advancement in CT‑guided complex PCI. Topic editors: Brunilda Alushi, Massimiliano Fusaro Source: https://www.frontiersin.org/research-topics/81111/from-ct-suite-to-catheterisation-laboratory-cardiac-ct-as-a-procedural-roadmap-for-complex-percutaneous-coronary-intervention